Provider Demographics
NPI:1740438050
Name:MACAROL, SOPHIA A (PAC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:A
Last Name:MACAROL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:A
Other - Last Name:ZIELINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:708-388-5500
Mailing Address - Fax:708-388-5672
Practice Address - Street 1:2100 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5487
Practice Address - Country:US
Practice Address - Phone:815-999-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003254363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL964290025OtherLOCALITY 16
IL964290025OtherLOCALITY 16